1004. Using the Standardized Antimicrobial Administration Ratios to monitor the influence of antimicrobial stewardship activities
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
  • Livorsi ID week abstract.pdf (565.4 kB)
  • Background: The National Healthcare Safety Network (NHSN) provides an Antimicrobial Use (AU) option to assist antimicrobial stewardship programs (ASPs) with analysis of their AU data. The AU option summarizes data as a Standardized Antimicrobial Administration Ratio (SAAR), an indirectly standardized metric for comparing observed to predicted days of therapy. A key question, and the subject of this study, is whether the SAAR reflects the impact of greater Infectious Disease (ID) physician involvement in prospective audit-and-feedback (PAF).

    Methods: The primary ASP activity at our 200-bed hospital is PAF. During the study dates (2013-15), an ID physician met with clinical pharmacists twice a week to discuss audits of broad-spectrum antimicrobials (BSAs). During Phase 1 (baseline – 1/2014), audits were initiated by the clinical pharmacists, and in Phase 2 (2/2014-12/2015), by an ID physician. All audit feedback was communicated to the primary prescriber by the team pharmacist and, if questions arose, by the ID physician. AU data submitted to NHSN were summarized using SAARs for several different groups of antimicrobials.

    Results:  The program averaged 61.5 PAF recommendations per month during the 12 months of Phase 2 when process data were collected. The most common feedback to prescribers was to stop antimicrobials (40.4%) or de-escalate therapy (32.4%).

    The SAAR decreased across multiple categories during pairwise-years (p<0.0001), with the exception of 2015 vs. 2014 changes in the SAARs for BSAs used for community-acquired infections (p=0.37) and All antibiotic agents (p=0.78) (Table 1). The largest reductions were seen in the SAARs for Anti-MRSA agents and BSAs used for hospital-onset infections.

    Conclusion: SAARs were useful in monitoring ASP activities, and declines in SAAR values suggest direct involvement of an ID physician in PAF had a measurable impact on antimicrobial prescribing.

    Table 1. Facility-level Standardized Antimicrobial Administration Ratios (SAAR), 2013-2015




    SAAR by Antimicrobial Category

    BSAs predominantly used for hospital-onset infections

    BSAs predominantly used for community-acquired infections

    Anti-MRSA agents

    All antibiotic agents
















    Daniel Livorsi, MD, MSc1,2, Erin O'leary, MPH3, Tamra Pierce, PharmD4, Lindsey Reese, MD4, Katharina Van Santen, MSPH3, Daniel Pollock, MD3, Jonathan R. Edwards, MStat3 and Arjun Srinivasan, MD, FSHEA3, (1)Iowa City VA Medical Center, Iowa City, IA, (2)University of Iowa College of Medicine, Iowa City, IA, (3)Centers for Disease Control and Prevention, Atlanta, GA, (4)Roudebush VA Medical Center, Indianapolis, IN


    D. Livorsi, None

    E. O'leary, None

    T. Pierce, None

    L. Reese, None

    K. Van Santen, None

    D. Pollock, None

    J. R. Edwards, None

    A. Srinivasan, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.